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PubMedDate not supplied

The relationship between coping strategies and GHQ-scores in nurses.

This paper discusses the development of a situation specific questionnaire for measuring coping with shiftwork. Previously, no standardized measure appears to have been developed, even though coping behaviour is considered to be an important factor in determining tolerance to shiftwork. The results from this study indicated that the present questionnaire may have some potential. Its psychometric qualities were relatively good. Coping scores were related to psychological health, measured by GHQ-12. Analysis of variance showed a main effect of only one of the subscales (disengagement strategies) on GHQ and also a reliable interaction between disengagement and engagement on GHQ-scores. Further research into the effect of coping strategies on shiftwork tolerance is suggested.

Adaptation, Psychological↗
PubMedDate not supplied

Working the night shift: preparation, survival and recovery--a guide for junior doctors.

Following the implementation of the European Working Time Directive Regulations, almost all junior doctors in the UK now work full night-shifts. An RCP 50-member working group was established to develop a practical guide to help junior doctors prepare, survive and recover from working night shifts. The guide, set out in this paper, examines the evidence concerning the hazards of shiftwork, and techniques that can be used to reduce risk. The main advice is to minimise sleep debt by taking additional two-hour sleeps in the afternoon before a shift, and 20- to 45-minute naps during the night shift. It is hoped that the advice will make the challenge of night shift work not only easier to tolerate, but also safer for both hospital patients and their doctors.

Biological Clocks↗
PubMed2006

Impact of shift work on the health and safety of nurses and patients.

Shift work generally is defined as work hours that are scheduled outside of daylight. Shift work disrupts the synchronous relationship between the body's internal clock and the environment. The disruption often results in problems such as sleep disturbances, increased accidents and injuries, and social isolation. Physiologic effects include changes in rhythms of core temperature, various hormonal levels, immune functioning, and activity-rest cycles. Adaptation to shift work is promoted by reentrainment of the internally regulated functions and adjustment of activity-rest and social patterns. Nurses working various shifts can improve shift-work tolerance when they understand and adopt counter measures to reduce the feelings of jet lag. By learning how to adjust internal rhythms to the same phase as working time, nurses can improve daytime sleep and family functioning and reduce sleepiness and work-related errors. Modifying external factors such as the direction of the rotation pattern, the number of consecutive night shifts worked, and food and beverage intake patterns can help to reduce the negative health effects of shift work. Nurses can adopt counter measures such as power napping, eliminating overtime on 12-hour shifts, and completing challenging tasks before 4 am to reduce patient care errors.

Adaptation, Physiological↗
PubMed1989

Circadian characteristics influencing interindividual differences in tolerance and adjustment to shiftwork.

The study was carried out to evaluate whether shiftworkers showing different long-term tolerance to shiftwork differ in their circadian adjustments and/or in some behavioural characteristics. Three groups of eight workers, engaged on three shifts in a graphic plant and matched for age and work experience, were selected according to the presence or not of complaints related to shiftwork: (1) no complaints; (2) nervous complaints (anxiety/depression, severe sleep disturbances); (3) digestive disorders (gastroduodenitis, peptic ulcer). They answered questionnaires on family conditions, health status, rigidity of sleeping habits, ability to overcome drowsiness, morningness, manifest anxiety. They also recorded several physiological parameters (oral temperature, grip strength, peak expiratory flow rate, pulse rate, sleep hours) during day and night-shifts. The data obtained indicate that the characteristics of flexibility of sleeping habits, ability to overcome drowsiness, and lower manifest anxiety, are associated with better tolerance to shiftwork. These characteristics do not seem to influence the adjustment of the circadian rhythm of oral temperature passing from day to night-shifts and vice versa. Conversely, morningness appeared to be unrelated to long-term tolerance, but did influence circadian adjustments and sleep behaviour. Among the groups, the subjects with digestive disorders showed a greater phase shift and a reduction of the amplitude on night-work, suggesting a possible relationship also between the short-term circadian adjustment and the long-term tolerance to shiftwork, as pointed out by other authors.

Adaptation, Psychological↗
PubMed1988

Physical fitness and other individual factors relating to the shiftwork tolerance of women.

Maximal oxygen consumption (VO2max), muscle strength (MS) and physical activity were compared to age, shiftwork experience, morningness, personality traits and social factors intervening in the shiftwork tolerance of 128 women. The subjects were nurses and nursing aids working irregular shifts in a hospital. Neuroticism was the most powerful negative factor connected to higher fatigue and various symptoms of the subjects. High VO2max and good MS were, on the other hand, the most important positive factors connected to lower fatigue and musculoskeletal symptoms and better sleep quality of the subjects. In different shifts, fatigue, sleep length and quality were influenced most by morningness. It is concluded that physical fitness is an important individual factor explaining the variations of shiftwork tolerance in women.

Adult↗
PubMed1983

[Desynchronization of the circadian rhythm of oral temperature in young human subjects with poor tolerance for night work].

15 night workers (mean age, 28 years; mean seniority 1.5 years) volunteered to measure their oral temperature (clinical thermometers 0.05 degrees C precision) 5 times/24 hrs. during a 21 day span. Time series were analyzed individually according to 3 methods. 11 of the subjects with a good tolerance had (with one exception) their prominent circadian period tau equal to 24 hrs. as well as a relatively large circadian amplitude (A from 0.19 to 0.42 degrees C). By contrast, subjects with a poor tolerance (sleep disorders, persisting fatigue, psychological troubles, etc.) had a tau value ranging from 24.9 to 25.7 hrs. associated with a relatively small rhythm amplitude (A from 0.04 to 0.13 degrees C). These results support the hypothesis that a desynchronisation of circadian rhythms help to explain why certain subjects do not tolerate shiftwork.

Adult↗
PubMed1999

Studies of psychophysiological and temporal conditions of work.

The main areas studied until the 70s were fatigue and rest. Many tests for fatigue were examined, and studies failed to find their practical use. Fatigue grows according to the positive acceleration curve while recovery grows according to the negative acceleration curve. Different mechanisms are involved in intelligence test performance when subjects are fatigued and when rested. Contrary to the pharmacological, psychological stimulants increase performance without adverse effects on the organism. The differences in absenteeism between male and female workers are related to family duties. After the 70s, research was focused on shiftwork. Shiftwork is associated with imposed change in a worker's normal activity pattern. It brings about fatigue, negative moods, and impaired health, sleep, safety, and working capacity. The shiftwork tolerance is connected with introversion, neuroticism, morningness, control of behavioural arousal, and parameters of circadian rhythms. The most important predictors of shiftwork tolerance are dimensions of control of behavioural arousal and morningness, while the most important criterion is sleep quality.

Central Nervous System Stimulants↗
PubMed2000

Sleep-wake behavior of shift workers using wrist actigraph.

The sleep-wake behavior and the effects of aging on the tolerance of night shift were investigated using wrist actigraph for 12 Korean male workers of a continuous full-day three-team three-shift system. The wrist actigraph data were obtained for about 21 days (1 shift cycle) for each subject. During night duty, total sleep time decreased, the number of naps and nap length during on-duty or off-duty periods increased, and the level of activity decreased with increasing age. These results suggest that the tolerance to night shift becomes weaker with increasing age.

Adult↗
PubMedDate not supplied

The use of the Circadian Type Inventory as a measure of the circadian constructs of vigour and rigidity.

The Circadian Type Inventory (Folkard 1987) was administered to 191 students (150 females and 41 males). Corrected item to total correlations for both the Vigour and Rigidity scales were low to moderate. The internal reliabilities of the scales indicate that Vigour is statistically more homogeneous (0.74) than Rigidity (0.58). In the absence of the original CTI correlation matrix, replication using a 2-factor principal component varimax solution was undertaken. It explained only 26.7% of the variance. Post hoc factor analyses yielded 3 factors which explained 33.4% of the variance. The relatively low amounts of variance explained and the inadequate transfer of the circadian constructs of Rigidity and Vigour into question items does not recommend the use of the CTI to measure circadian rhythm characteristics in order to predict tolerance to shiftwork.

Adolescent↗
PubMed2001

Circadian rhythm, shiftwork and you!

Chronobiological knowledge is increasing and the relationship between this knowledge and shiftwork is becoming clearer. This, in turn, is highlighting a need to facilitate a mix of permanent (day, evening and night) and rotational shift systems within individual wards or units. Is it perhaps time to allow greater flexibility in how individual nurses deal with the profession's need to care for patients throughout the 24 hour period? This review will focus on the 24 hour day-night or circadian rhythms and the consequences of the disruption of these rhythms as nurses undertake shiftwork and other activities which demand efficient functioning at times when an individual's circadian rhythms are expecting them to be at rest. As disruption of these rhythms is essentially unavoidable when 24 hour care is required, the choice becomes one of determining a preference for tolerable rhythm desynchrony and shorter more frequently occurring episodes of night work, or some degree of rhythm synchrony and adaptation during slightly longer but less frequent episodes of rhythm disruption.

Adaptation, Physiological↗
PubMed2001

Shiftwork in the hot environment.

The study examined the risks of heat induced workplace accidents (textile industry, N = 4125) and the heat tolerability of the rotating day (morning and afternoon, N = 16) and permanent night shift workers (N = 13) in hot-dry and hot-humid environment (34 to 49 degrees C, 50-80% RH; 31 to 42 degrees C ET, Basic). Accident prevalence was significantly high in the summer months (May-June) when the ambient temperature ranged between 42 and 48 degrees C (hot-dry). The influence of hot climate in accident causation was evident from the shift-wise variations in the occurrence of accidents. The longitudinal study showed that the night workers were more vulnerable and less tolerant to heat, the tolerance time being less by about 15% (31 degrees C ET) to 40% (39 degrees C ET), compared to the rotating day workers. The relationship of the segmental and compartmental temperatures (segmental triggering response) played a critical role in heat dissipation/accumulation mechanism, and reflected in the heat tolerability of the day and night workers.

Accidents, Occupational↗
PubMed2002

Using a unit assessment tool to optimize patient flow and staffing in a community hospital.

BACKGROUND: Hospital environments are too often characterized by delays for patients receiving diagnostic testing and prolonged waiting times to complete needed therapy. Frequently there is confusion in scheduling, related at least in part to the complex interplay of clinical acuity and highly individualized care. Luther Midelfort recently began to change the process of patient flow to improve access to care, optimize outcomes by enabling timely intervention, and decrease the wasting of resources. UNIT ASSESSMENT TOOL: The hospital developed a unit assessment tool based on the traffic light concept, which consisted of an assessment of current capacity and a graded, color-coded "workload tolerance" for each hospital unit. Each unit can instantly update its own status and query those of other work environments in the hospital. EXPERIENCE WITH THE UNIT ASSESSMENT TOOL: For most of the January-July 2001 period, there was generally a progressive decrease in the percentage of time that the units were coded as red (unit closed to new admissions), with concurrent increases in the percentage of time that the units were coded as green (unit open). Use of the tool appears to have contributed to a dramatic increase in staff satisfaction. SUMMARY AND CONCLUSIONS: The key to regulating patient flow has been to adopt a nursing-initiated capping trust policy whereby nurses are given the authority to limit new admissions. Initiatives are now under way to provide different units with novel models of resource sharing, ranging from flexible housekeeping to "flying nurse squads" to assist units that have become red.

Appointments and Schedules↗
PubMed2004

Postprandial metabolic profiles following meals and snacks eaten during simulated night and day shift work.

Shift workers are known to have an increased risk of developing cardiovascular disease (CVD) compared with day workers. An important factor contributing to this increased risk could be the increased incidence of postprandial metabolic risk factors for CVD among shift workers, as a consequence of the maladaptation of endogenous circadian rhythms to abrupt changes in shift times. We have previously shown that both simulated and real shift workers showed relatively impaired glucose and lipid tolerance if a single test meal was consumed between 00:00-02:00 h (night shift) compared with 12:00-14:00 h (day shift). The objective of the present study was to extend these observations to compare the cumulative metabolic effect of consecutive snacks/meals, as might normally be consumed throughout a period of night or day shift work. In a randomized crossover study, eight healthy nonobese men (20-33 yrs, BMI 20-25kg/m2) consumed a combination of two meals and a snack on two occasions following a standardized prestudy meal, simulating night and day shift working (total energy 2500 kcal: 40% fat, 50% carbohydrate, 10% protein). Meals were consumed at 01:00/ 13:00 h and 07:00/19:00h, and the snack at 04:00/16:00 h. Blood was taken after an overnight fast, and for 8 h following the first meal on each occasion, for the measurement of glucose, insulin, triacylglycerol (TAG), and nonesterified fatty acids (NEFA). RM-ANOVA (factors time and shift) showed a significant effect of shift for plasma TAG, with higher levels on simulated night compared to day shift (p < 0.05). There was a trend toward an effect of shift for plasma glucose, with higher plasma glucose at night (p = 0.08), and there was a time-shift interaction for plasma insulin levels (p < 0.01). NEFA levels were unaffected by shift. Inspection of the area under the plasma response curve (AUC) following each meal and snack revealed that the differences in lipid tolerance occurred throughout the study, with greatest differences occurring following the mid-shift snack. In contrast, glucose tolerance was relatively impaired following the first night-time meal, with no differences observed following the second meal. Plasma insulin levels were significantly lower following the first meal (p < 0.05), but significantly higher following the second meal (p < 0.01) on the simulated night shift. These findings confirm our previous observations of raised postprandial TAG and glucose at night, and show that sequential meal ingestion has a more pronounced effect on subsequent lipid than carbohydrate tolerance.

Adult↗
PubMed1990

[Subjective wellbeing of shift workers in relation to individual characteristics of circadian rhythm].

With a goal to test the influence of individual traits of circadian rhythms on the tolerance of shiftwork a circadian questionnaire has been developed with the method of factors analysis. There are two scales in the final form of the questionnaire representing two chronobiological characteristics: morningness - eveningsness (circadian phase-position) and flexibility of the sleep-wake-rhythm. Sex- and age-norms exist for the two scales. Reliability and validity have been demonstrated. The results of an epidemiological study shows that the hypothesis of better adjustment to shiftwork of evening-types can not be verified. A better predictor of tolerance to shift work in terms of wellbeing seems to be the individual circadian trait flexibility of sleep-wake-rhythm.

Adaptation, Physiological↗
PubMed2001

Age and the subjective experience of shiftwork.

The objective of this study was to examine age related effects of shiftwork albeit difficult to tease apart the natural effects of aging, and lifestyle or behaviour, or job done, over time and the shifts a person works. This is an issue of concern because the numbers of shiftworkers over 45 are increasing. Participants were 306 police officers who had worked a new rota for approximately 6 months. Three age groups were compared (1 = 20-32.9, 2 = 33-39.9, 3 = 40+) using a range of shiftwork-related measures and multivariate analysis of covariance (controlling for shiftwork experience and other individual differences). Younger officers tended to report significantly better attitudes towards their shiftwork, better adjustment to night-bound shifts, greater job satisfaction and organisational commitment, lower fatigue and longer sleep durations. Older shiftworkers reported significantly higher morningness and lower sleep need than the younger officers. This concurred with existing research that implicates such variables in the mechanism(s) involved in age-related tolerance to shiftwork. It was also evident that the older group tended to resort to greater caffeine intake on all shifts. The findings offer tentative support for the position that age can be linked to depleted shiftwork tolerance but the issue of establishing the relative impacts of aging, lifestyle, behaviour, work type and the rota worked remains to be a challenge.

Adaptation, Psychological↗
PubMed2006

Are individuals' nighttime sleep characteristics prior to shift-work exposure predictive for parameters of daytime sleep after commencing shift work?

This study aimed to examine prospectively whether individual nighttime sleep characteristics at baseline (prior to shift-work exposure) are related to parameters of daytime sleep after commencing shift work. A longitudinal field study was carried out with novice police officers of the Dutch Police Force. A total of 26 subjects were examined at baseline before they entered shift work and re-examined during follow-up sessions after four and twelve months of shift-work exposure. Wrist actigraphy and sleep diaries were used to study nocturnal sleep at baseline and daytime sleep after night shifts during follow-up sessions. As outcome variables, estimated total sleep time, sleep efficiency, and subjective sleep quality were analyzed. Daytime total sleep time showed a 66 min decline during the first year of shift-work exposure. Systematic inter-individual differences were observed for daytime total sleep time and subjective sleep quality (explaining 53% and 38% of the variance, respectively), suggesting potential predictability of these sleep parameters. Although no predictors were found for daytime total sleep time, the subjective quality of nighttime sleep before the onset of shift work predicted 40% of the variance in the subjective quality of daytime sleep after commencing shift work. Follow-up studies may reveal whether the subjective quality of baseline nighttime sleep also predicts long-term overall tolerance for shift work.

Adult↗
PubMed2001

Shiftwork locus of control effects in police officers.

Personality and experientially-based differences are suggested to moderate the negative effects of shiftworking. This investigation was one of a series of studies aimed at examining the relationship between internal locus of control (internality) and commonly reported outcomes of exposure to shiftworking. The study concentrated on whether or not shiftwork-specific internality appeared to be associated with better experiences for two groups of shiftworkers on different shift rotas. The Shiftwork Locus of Control (SHLOC) scale was completed by each group along with a range of outcome measures (including: sleep disturbance, alertness on shift, psychological well-being, disturbance of social and family life, and fatigue). The analyses controlled for for age, shiftwork experience and years of service effects. The results showed that for the majority of outcome variables, the higher internality was associated with significantly lower levels of shiftwork problems, especially when compared to the low internality group. The findings of this study further support the use of shiftwork-specific locus of control in shiftwork research as an indicator of potentially better tolerance, and possibly as part of an occupational health monitoring process to aid the targeting of interventions.

Adaptation, Psychological↗
PubMed1998

Individual and social determinants of shiftwork tolerance.

This paper reviews evidence published on individual and social determinants of shiftwork tolerance since 1993. In agreement with earlier reviews, individual differences show only some low and inconsistent concurrent covariation with shiftwork tolerance, and no predictive power for these measures has been found. It is thus not possible to predict future shiftwork tolerance from individual differences. Social conditions are also related to shiftwork tolerance, although again predictive power has not been demonstrated. An examination of the reasons for this state of the art suggested means of improving the relevance and usability of future research in this area.

Circadian Rhythm↗